71 results on '"L., Thabet"'
Search Results
2. DISTRIBUTION GÉOGRAPHIQUE DES CARBAPÉNÉMASES CHEZ LES BRÛLÉS TUNISIENS.
- Author
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A., Mokline, S., Zarrouk, I., Jemi, H., Fraj, B., Gasri, M., Ben Saad, L., Thabet, and A. A., Messadi
- Abstract
Copyright of Annals of Burns & Fire Disasters is the property of Euro-Mediterranean Council for Burns & Fire Disasters and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2024
3. Corrélation entre la consommation des antibiotiques et la résistance du Pseudomonas aeruginosa chez les brûlés
- Author
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M. Lamloumi, B. Maamar, S. Dhraief, M. Gargouri, A. Messaidi, and L. Thabet
- Published
- 2023
4. LA PROCALCITONINE: BIOMARQUEUR DE CHOIX POUR GUIDER L'INITIATION, LA MODIFICATION ET L'ARRÊT DE L'ANTIBIOTHÉRAPIE CHEZ LES BRÛLÉS SEPTIQUES?
- Author
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A., Mokline, S., Sboui, H., Fredj, M., Ben Saad, I., Eljemi, B., Gasri, L., Thabet, and A. A., Messadi
- Subjects
BURN care units ,INTENSIVE care units ,SYMPTOMS ,TREATMENT duration ,CALCITONIN - Abstract
Copyright of Annals of Burns & Fire Disasters is the property of Euro-Mediterranean Council for Burns & Fire Disasters and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2023
5. Hypernatremia Risk Factors And Prognostic Impact In Burn Patients: A Case Control Study
- Author
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I, Sedghiani, A, Mokline, H, Fredj, N, Bouguezzi, F Z, Gamara, M, Ben Saad, L, Thabet, and A A, Messadi
- Subjects
Research Article - Abstract
Hypernatremia is associated with poor outcomes in critically ill patients. Hypernatremia risk factors in burned patients are not well studied. We aimed to identify hypernatremia risk factors and to evaluate outcomes in burned patients admitted to our burns intensive care unit. A case control study was conducted in adult burned patients hospitalized between January 1st 2017 and December 31st 2019. Cases who developed hypernatremia (145 meq/L) during hospitalization were matched 1:1 with controls based on age and total burn surface area. There were 57 cases and 57 controls with a mean age of 41 ± 18 years. The majority of patients had major burns (n=99, 86.8%). The time onset of hypernatremia was seven days post burn. Compared to controls, the case group mostly consisted of transferred patients with longer time from injury to intensive care unit admission. Inhalation injury, mechanical ventilation, intravenous fosfomycin and colistin were associated with hypernatremia. Admission to the intensive care unit after six hours post-burn was the independent risk factor (OR=4.5). Hypernatremia was associated with longer length of stay and with higher mortality. We conclude that delayed management, inhalation injury, mechanical ventilation, fosfomycin and colistin administration are the main hypernatremia risk factors in burned patients.L’hypernatrémie est un paramètre pronostic défavorable chez les patients de réanimation. Ses facteurs de risque n’ont pas été bien étudiés chez les brûlés. Nos objectifs étaient d’identifier les facteurs de risque d’hypernatrémie et d’évaluer son impact sur le pronostic des brûlés hospitalisés dans notre unité de réanimation. Une étude cas-témoins a été menée chez des brûlés hospitalisés entre le 1er janvier 2017 et le 31 décembre 2019. Les cas (hypernatrémie145 meq/L pendant l’hospitalisation) ont été appariés 1/1 avec des témoins, en tenant compte de l’âge et de la surface brûlée. Nous avons colligé 57 cas et 57 témoins âgés de 41±18 ans. La plupart des patients (n=99 soit 86,8%) souffraient de brûlures étendues. L’hypernatrémie s’est installée après sept jours des brûlures. Les cas avaient plus souvent été transférés d’une autre institution et étaient pris en charge dans le service après un délai plus long. Les lésions d’inhalation, la ventilation mécanique, la fosfomycin et la colimycine étaient les facteurs de risque d’hypernatrémie. L’admission en réanimation au-delà de six heures en était le facteur de risque indépendant (OR=4,5). L’hypernatrémie était associée à une durée de séjour plus longue et à une mortalité plus élevée. Nous concluons que la prise en charge tardive, les lésions d’inhalation, la ventilation mécanique, la fosfomycine et la colimycine sont les facteurs de risque d’hypernatrémie chez les brûlés.
- Published
- 2020
6. The effect of initiating intravenous oxytocin infusion before uterine incision on the blood loss during elective cesarean section: a randomized clinical trial
- Author
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Ihab Elnashar, Ahmed A. Abdelaleem, Andrew L Thabet, Esraa Badran, and Ahmed M. Abbas
- Subjects
Adult ,Blood transfusion ,Term Birth ,medicine.medical_treatment ,Blood Loss, Surgical ,Hematocrit ,Oxytocin ,Umbilical cord ,Umbilical Cord ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Pregnancy ,law ,Atony ,Statistical significance ,Humans ,Medicine ,030212 general & internal medicine ,Infusions, Intravenous ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,Cesarean Section ,business.industry ,Postpartum Hemorrhage ,Pregnancy Outcome ,Obstetrics and Gynecology ,Surgical Instruments ,Constriction ,medicine.anatomical_structure ,Elective Surgical Procedures ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Gestation ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
Objective: This study compares the effect of starting intravenous oxytocin infusion early before uterine incision versus late after umbilical cord clamping on the blood loss during elective cesarean section (CS). Methods: A single-blinded randomized clinical trial conducted on 200 pregnant women at term (>37 weeks) gestation scheduled for elective CS were assigned to either IV infusion of 30 IU of oxytocin started before uterine incision (Group I) or started immediately after clamping the umbilical cord (Group II). The primary outcome was the mean volume of blood loss during CS. The secondary outcomes included the mean volume of postoperative blood loss, the mean reduction in the hemoglobin and hematocrit levels, the need for additional uterotonics, blood transfusion and additional surgical procedures. Results: The baseline characteristics of both groups are quiet similar. No statistical significant difference between both groups as regard to pre- and postpartum hemoglobin levels (p = .06 and 0.24 respectively) and hematocrit values (p = .12 and .51 respectively). There was a significant reduction in the intraoperative blood loss in group I compared with group II (432.7 ± 90.6 versus 588.9 ± 96.3 mL respectively, p = .001). The need for additional uterotonics was more frequent in the group II (19 women) than in group I (seven women) with statistical significance (p = .002). No differences between both groups regarding the need for blood transfusion or additional surgical procedures. Conclusions: Initiating intravenous oxytocin infusion before uterine incision during elective CS could be associated with reduction in the intraoperative blood loss and the need for additional uterotonics.
- Published
- 2018
7. CORRÉLATION ENTRE LA CONSOMMATION D'ANTIBIOTIQUES ET LES TAUX D'ANTIBIORÉSISTANCE CHEZ P. ÆRUGINOSA DANS UN SERVICE DE RÉANIMATION DES BRÛLÉS TUNISIEN: ÉTUDE SUR 6 ANS (2014-2019).
- Author
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L., Thabet, S., Frigui, A., Mellouli, M., Gargouri, B., Maamar, I., Harzallal, J., Boukadida, and A. A., Messadi
- Subjects
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DRUG resistance in bacteria , *BACTERIAL ecology , *BURN care units , *PROGNOSIS , *DRUG resistance , *AMIKACIN , *ANTIBIOTICS , *IMIPENEM - Abstract
Antibiotics are one of the greatest advances in modern medicine. Antibiotic resistance is one of the most serious threats to global health, aggravating the prognosis of immunocompromised patients, especially burn patients. Our objective was to study the consumption of antibiotics of critical importance according to the WHO and the correlation between antibiotic resistance in Pseudomonas æruginosa and the consumption of these antibiotics. Our study took place in the Medical Laboratory in collaboration with the Trauma and Burn Center's Burn Unit in Tunisia. In our retrospective study, 1384 non-repetitive strains of Pseudomonas æruginosa responsible for colonization or infection were included, between January 2012 and December 2019. Pseudomonas æruginosa was the most isolated bacterial strain in the service, with an average rate of 15.9% of the service's bacterial ecology. The antibiotic resistance rates tested were high: 77.1% to piperacillin-tazobactam, 56% to ceftazidime, 74.9% to imipenem, 78.8% to amikacin, 54.7% to ciprofloxacin and 32.8% to fosfomycin. Among our strains, 81.8% were multi drug-resistant strains. The analysis of the correlation between the level of consumption of antibiotics and the antibiotic resistance levels in Pseudomonas æruginosa showed that the increased consumption of piperacillin-tazobactam increased resistance not only to piperacillin-tazobactam but also to imipenem and amikacin as well as multi drug resistance. Similarly, the increase in the consumption of fosfomycin correlates with resistance to piperacillin-tazobactam and imipenem. [ABSTRACT FROM AUTHOR]
- Published
- 2021
8. COLONISATION ET INFECTION À ACINETOBACTER BAUMANNII DANS UNE UNITÉ DE RÉANIMATION DES BRÛLÉS EN TUNISIE.
- Author
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A., Mellouli, B., Maamar, F., Bouzakoura, A. A., Messadi, and L., Thabet
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ACINETOBACTER baumannii ,BURN care units ,BACTERIAL ecology ,CIPROFLOXACIN ,TRAUMA centers ,MULTIDRUG resistance ,CEFTAZIDIME ,RESPIRATORY infections - Abstract
Copyright of Annals of Burns & Fire Disasters is the property of Euro-Mediterranean Council for Burns & Fire Disasters and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2021
9. HYPERNATREMIA RISK FACTORS AND PROGNOSTIC IMPACT IN BURN PATIENTS: A CASE CONTROL STUDY.
- Author
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I., Sedghiani, A., Mokline, H., Fredj, N., Bouguezzi, F. Z., Gamara, M., Ben Saad, L., Thabet, and A. A., Messadi
- Subjects
PROGNOSIS ,HYPERNATREMIA ,BURN patients ,BURN care units ,INTENSIVE care units ,INHALERS - Abstract
Copyright of Annals of Burns & Fire Disasters is the property of Euro-Mediterranean Council for Burns & Fire Disasters and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2021
10. Description of an original integron encompassing blaVIM-2, qnrVC1 and genes encoding bacterial group II intron proteins in Pseudomonas aeruginosa
- Author
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L. Thabet, A. Laffargue, P. T. Belotti, L. Coulange-Mayonnove, Véronique Dubois, A. A. Messadi, Catherine André, Claudine Quentin, Corinne Arpin, and Fatima M’Zali
- Subjects
Microbiology (medical) ,Tunisia ,Endemic Diseases ,Gene Transfer, Horizontal ,Burn Units ,Molecular Sequence Data ,Biology ,medicine.disease_cause ,Integron ,beta-Lactam Resistance ,beta-Lactamases ,Integrons ,Microbiology ,Plasmid ,medicine ,Humans ,Pseudomonas Infections ,Pharmacology (medical) ,Gene ,Escherichia coli ,Pharmacology ,Genetics ,Pseudomonas aeruginosa ,Gene Expression Profiling ,Intron ,Sequence Analysis, DNA ,Group II intron ,Introns ,Anti-Bacterial Agents ,Imipenem ,Infectious Diseases ,Gene cassette ,Genes, Bacterial ,Conjugation, Genetic ,biology.protein ,Transformation, Bacterial ,Burns - Abstract
Objectives A burn unit of a hospital in Tunis underwent an endemic situation caused by imipenem-resistant Pseudomonas aeruginosa. For nine non-repetitive isolates of a clonal VIM-2-producing strain, the blaVIM-2 genetic background was characterized and the associated qnrVC1 gene molecularly analysed. Methods The imipenem resistance mechanism was investigated by phenotypic and molecular tests, and resistance transfer was studied by conjugation and transformation experiments. The integron's structure was characterized by sequencing, and qnrVC1 expression was explored after cloning experiments. Results The nine VIM-2-producing strains were collected from eight patients and one environmental sample. All transfer assays failed, suggesting a chromosomal location of blaVIM-2. This latter was found to be part of a class 1 integron of ∼7500 bp, which also contains blaOXA-2, aadA1 and two copies of the aadB, arr-6 and qnrVC1 genes. qnrVC1 exhibited higher homology with the chromosomally encoded qnr genes of Vibrionaceae than with plasmid-mediated qnr genes of Enterobacteriaceae. The qnrVC1 gene cassette possesses a promoter allowing its expression, and it conferred decreased fluoroquinolone susceptibility to Escherichia coli. Additionally, on the same integron, genes encoding an uncommon group IIC-attC intron were detected. Conclusions A VIM-2-producing P. aeruginosa outbreak led us to characterize an integron harbouring a qnrVC1 cassette and a new group IIC-attC intron. This is the first known description of a qnr determinant in a P. aeruginosa strain. Its presence conferred a low level of resistance to quinolones in E. coli, which might favour the emergence of highly resistant mutants.
- Published
- 2015
11. BACTÉRIÉMIES NOSOCOMIALES: ÉPIDÉMIOLOGIE CLINIQUE ET BACTÉRIOLOGIQUE CHEZ LES BRÛLÉS.
- Author
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S., Frigui, Y., Bourbiaa, A., Mokline, H., Naija, A. A., Messadi, and L., Thabet
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BURN care units ,MULTIDRUG resistance in bacteria ,TRAUMA centers ,INTENSIVE care units ,COLISTIN ,ACINETOBACTER infections - Abstract
Copyright of Annals of Burns & Fire Disasters is the property of Euro-Mediterranean Council for Burns & Fire Disasters and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2021
12. COLONISATION ET INFECTION À PSEUDOMONAS ÆRUGINOSA DANS UN SERVICE DE RÉANIMATION DES BRÛLÉS: ÉTUDE SUR 8 ANS.
- Author
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S., Frigui, A. A., Messadi, and L., Thabet
- Subjects
BURN care units ,BACTERIAL ecology ,BURNS & scalds ,MULTIDRUG resistance ,DRUG resistance in bacteria ,COLISTIN ,CEFTAZIDIME ,MULTIDRUG-resistant tuberculosis - Abstract
Copyright of Annals of Burns & Fire Disasters is the property of Euro-Mediterranean Council for Burns & Fire Disasters and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2020
13. Evolution of an Incompatibility Group IncA/C Plasmid Harboring bla CMY-16 and qnrA6 Genes and Its Transfer through Three Clones of Providencia stuartii during a Two-Year Outbreak in a Tunisian Burn Unit
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Véronique Dubois, Corinne Arpin, J. Boukadida, H. Yassine, L. Coulange-Mayonnove, L. Thabet, Claudine Quentin, Catherine André, and A. A. Messadi
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Pharmacology ,clone (Java method) ,Genetics ,biology ,Providencia stuartii ,medicine.medical_treatment ,Providencia ,biology.organism_classification ,Integron ,Microbiology ,SmaI ,Infectious Diseases ,Plasmid ,biology.protein ,Beta-lactamase ,medicine ,Pharmacology (medical) ,Insertion sequence - Abstract
During a 2-year period in 2005 and 2006, 64 multidrug-resistant Providencia stuartii isolates, including 58 strains from 58 patients and 6 strains obtained from the same tracheal aspirator, were collected in a burn unit of a Tunisian hospital. They divided into four antibiotypes (ATB1 to ATB4) and three SmaI pulsotypes (PsA to PsC), including 49 strains belonging to clone PsA (48 of ATB1 and 1 of ATB4), 11 strains to clone PsB (7 of ATB2 and 4 of ATB3), and 4 strains to clone PsC (ATB3). All strains, except for the PsA/ATB4 isolate, were highly resistant to broad-spectrum cephalosporins due to the production of the plasmid-mediated CMY-16 β-lactamase. In addition, the 15 strains of ATB2 and ATB3 exhibited decreased quinolone susceptibility associated with QnrA6. Most strains (ATB1 and ATB3) were gentamicin resistant, related to an AAC(6′)-Ib′ enzyme. All these genes were located on a conjugative plasmid belonging to the incompatibility group IncA/C 2 of 195, 175, or 100 kb. Despite differences in size and in number of resistance determinants, they derived from the same plasmid, as demonstrated by similar profiles in plasmid restriction analysis and strictly homologous sequences of repAIncA/C 2 , unusual antibiotic resistance genes (e.g., aphA-6 ), and their genetic environments. Further investigation suggested that deletions, acquisition of the IS CR1 insertion sequence, and integron cassette mobility accounted for these variations. Thus, this outbreak was due to both the spread of three clonal strains and the dissemination of a single IncA/C 2 plasmid which underwent a remarkable evolution during the epidemic period.
- Published
- 2012
14. Clonality of Providencia stuartii isolates involved in outbreak that occurred in a burn unit
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A. Turki, N. Ben Saida, L. Thabet, K. Bouselmi, A. Messadi, and Jalel Boukadida
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Adult ,Male ,Adolescent ,Burn Units ,Esbl production ,Microbial Sensitivity Tests ,Providencia ,Aspirator ,Critical Care and Intensive Care Medicine ,Disease Outbreaks ,Microbiology ,Health services ,Drug Resistance, Multiple, Bacterial ,Genotype ,Pulsed-field gel electrophoresis ,Humans ,Medicine ,Typing ,Child ,Cross Infection ,biology ,business.industry ,Providencia stuartii ,Enterobacteriaceae Infections ,Outbreak ,General Medicine ,Middle Aged ,biology.organism_classification ,Electrophoresis, Gel, Pulsed-Field ,Emergency Medicine ,Equipment Contamination ,bacteria ,Female ,Surgery ,business ,Polymorphism, Restriction Fragment Length - Abstract
In order to investigate an outbreak of multidrug-resistant Providencia stuartii that occurred in a burn unit, we analyzed by pulsed-field gel electrophoresis (PFGE) all isolates of P. stuartii collected during 4 months of 2005 from patients and from a tracheal aspirator. Seventeen clinical isolates of P. stuartii, extended-spectrum beta-lactamase (ESBL) producing, were collected from 17 patients. All these isolates were nosocomially acquired. Three other isolates were collected from the aspirator probe, the aspirator reservoir and from the aspirator tube. Three different antibiotypes were identified without correlation with the genotype. Two PFGE types were obtained (types A and B) with predominance of one (type A) that was observed for 15 isolates. P. stuartii isolates collected from different components of the aspirator (probe, reservoir and tube) yielded PFGE type A. This study suggests the bi-clonality of the outbreak and that transmission of epidemic P. stuartii isolates was through a common source. The aspirator probe, contaminated from aspirator that functioned as a reservoir of bacteria, seems to be the route of transmission of P. stuartii. Furthermore, this study shows the utility of PFGE in typing for the purpose of understanding the epidemiological behaviour of P. stuartii and as a basis for the development of rational control strategies.
- Published
- 2008
15. PROFIL MOLÉCULAIRE ET RÉSISTANCE AUX ANTIBIOTIQUES DES ENTÉROBACTÉRIES PRODUCTRICES DE CARBAPÉNÈMASES CHEZ LE BRÛLÉ.
- Author
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B., Maamar, A. A., Messadi, and L., Thabet
- Subjects
BURN care units ,BURNS & scalds ,ANTIBIOTICS ,ENTEROBACTERIACEAE ,MEROPENEM ,IMIPENEM ,CEPHALOSPORINS ,COLISTIN - Abstract
Copyright of Annals of Burns & Fire Disasters is the property of Euro-Mediterranean Council for Burns & Fire Disasters and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2019
16. PROFIL BACTÉRIOLOGIQUE ET RÉSISTANCE AUX ANTIBIOTIQUES DES BACTÉRIES ISOLÉES DANS UN SERVICE DE RÉANIMATION DES BRÛLÉS DURANT SEPT ANS.
- Author
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A., Krir, S., Dhraief, A. A., Messadi, and L., Thabet
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BURN care units ,ACINETOBACTER baumannii ,ENTEROCOCCUS faecium ,DRUG resistance in bacteria ,VANCOMYCIN resistance ,BACTERIAL ecology ,CEFTAZIDIME - Abstract
Copyright of Annals of Burns & Fire Disasters is the property of Euro-Mediterranean Council for Burns & Fire Disasters and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2019
17. Les infections nosocomiales chez les traumatisés en réanimation
- Author
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S. Jaffel, M. Boussofara, B. Mahdi, and L. Thabet
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Infectious Diseases - Abstract
Introduction Les infections nosocomiales(IN) sont une realite preoccupante a laquelle sont confrontes tous les etablissements de soins. Par leur surcout ainsi que la morbidite et la mortalite qui pourraient leur etre attribuables, elles constituent un probleme majeur de sante publique. Le but de ce travail etait de determiner la frequence et le profil epidemiologique des IN chez les patients traumatises, d’identifier les facteurs de risque et les facteurs pronostiques et d’etudier le profil bacteriologique et la resistance aux antibiotiques des germes isoles. Materiels et methodes Il s’agissait d’une etude retrospective menee dans le service d’anesthesie reanimation du centre de traumatologie et grands brules (CTGB) sur une periode de trois ans (2011–2013). Resultats Cette etude a concerne 253 patients traumatises, dont 96 patients ont developpe au moins une IN. L’âge moyen des patients etait de 38,39 ans. Le sex-ratio etait de 5,8. Parmi nos patients, 70,7 % avaient un polytraumatisme ( n = 179) et 24,1 % avaient un traumatisme crânien ( n = 61). Des l’admission, 57,7 % des patients ( n = 146) avaient recu un traitement antibiotique. Le motif de prescription etait une fracture ouverte (ou equivalent) dans 68,5 % des cas ( n = 100). Au cours de leurs hospitalisations, une chirurgie a ete pratiquee chez 35,6 % des patients ( n = 90). La duree moyenne de sejour etait de 16,6 jours ± 16,9. La prevalence de l’IN etait de 37,9 % (96/253). La pneumopathie etait l’infection la plus frequente (47,9 %, n = 37)), suivie des bacteriemies (30,3 %, n = 36) et des infections urinaires (11,8 %, n = 16). Le delai moyen de survenue du 1 er episode infectieux etait de huit jours avec une mediane de six jours et des extremes allant de deux a 31 jours. La recherche de facteurs predictifs de complications au cours de l’IN a montre que la survenue d’un etat de choc septique et d’un syndrome de detresse respiratoire etait significativement correlee a l’âge et que l’insuffisance renale aigue etait significativement plus frequente ( p n = 30), suivie de Staphylococcus aureus (24,1 %, n = 27), d’acinetobacter baumannii (21,4 %, n = 24) et de pseudomonas aeruginosa (9,8 %, n = 11). Conclusion La prevalence elevee des IN chez les patients traumatises hospitalises en reanimation, les taux de resistance importants des especes en cause et l’accroissement de la duree de sejour qui en a resulte, doivent inciter a concentrer plus d’efforts sur la prevention.
- Published
- 2017
18. [Implementation of antimicrobial resistance surveillance and antibiotic consumption in an intensive care burn department]
- Author
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Amen Allah, Messadi, L, Thabet, K, Bousselmi, S, Oueslati, and Sayda, Ben Redjeb
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Population Surveillance ,Burn Units ,Drug Resistance, Bacterial ,Humans ,Drug Utilization ,Anti-Bacterial Agents - Abstract
The increasing consumption of antibiotics in hospitals and the economic implications of this increase lead to survey this consumption in the various hospital units.Our study proposes to measure the annual antibiotic use and antimicrobial resistance in an intensive care Burn department in order to manage the control measures.The study was conducted during a 5 year period (1 January 2000 to 31 December 2004). The average number of admissions was 204/year and the mean number of hospitalisation was 4036/year. Antimicrobial susceptibility testing was performed by disk diffusion method. Susceptibility testing data were stored in a laboratory data base using whonet 5.3 software. The consumption of following antibiotics: imipenem, ceftazidime, ofloxacin, ciprofloxacin, piperacillin-tazobactam was measured by antimicrobial density (AD) witch takes into account the quantity of antibiotics in Grams converted to daily defined dose (DDD) and number of hospitalization days. The daily defined dose (DDD) was proposed by WHO. The calculation of the AD for each molecule was earned Out according to the following formula: AD = (Quality consumed in for the particular antimicrobial x 1000) / (DDD for that antimicrobial x number of days of hospitalizations).There was statistically significant relationship between increasing use of ceftazidime and ceftazidime resistant Klebsiella pneumoniae (rs = 0.93; p = 0.O2) The use of ceftazidime was not significantly associated with resistance to this molecule in P. aeruginosa (rs = 0.76 p = 0.13). Conceerning the fluoroquinolones, there was statistically significant relation ship between increasing use of ciprofloxacin and rate ciprofloxacin resistant P. aeruginosa (rs = 0.89, P = 0.043). Furthermore, the consumption of ciprofloxacin was significantly correlated to imipenem resistance in P. aeruginosa (rs = 0.87, p = 0.05). However, the consumption of imipenem was not significantly correlated to resistance of this drug in P. aeruginosa (rs = 0.45; P = 0.4).The monitoring of both antibiotic consumption and antibiotic resistance is necessary to set up targeted policies and to control their effectiveness. Nevertheless this monitoring must be integrated into global policy of good use and control of antibiotics.
- Published
- 2009
19. Colistin in the treatment of sepsis from multi-resistant Gram-negative bacilli in burned patients
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F. Khairallah, H. Oueslati, L. Thabet, R. Ghanem, Y. Yahia, K. Bousselmi, A. Messaadi, and S. Melki
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business.industry ,General Medicine ,Gram negative bacilli ,Critical Care and Intensive Care Medicine ,medicine.disease ,Resistant tuberculosis ,Microbiology ,Sepsis ,Emergency Medicine ,Colistin ,Medicine ,Surgery ,business ,medicine.drug - Published
- 2009
20. Biomarkers of sepsis in burn patients
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A. Messaadi, R. Ghanem, H. Oueslati, L. Thabet, K. Bousselmi, and Y. Yahia
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Sepsis ,medicine.medical_specialty ,business.industry ,Emergency Medicine ,medicine ,Surgery ,General Medicine ,Critical Care and Intensive Care Medicine ,Intensive care medicine ,business ,medicine.disease - Published
- 2009
21. [Untitled]
- Author
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A. Messaadi, K. Bousselmi, A Bayoudh, L. Thabet, and M Memi
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medicine.medical_specialty ,Imipenem ,medicine.drug_class ,business.industry ,Antibiotics ,Ceftazidime ,Critical Care and Intensive Care Medicine ,Antimicrobial ,Ciprofloxacin ,Antibiotic resistance ,Internal medicine ,Intensive care ,medicine ,Vancomycin ,Intensive care medicine ,business ,medicine.drug - Abstract
The increasing consumption of antibiotics in hospitals and the economic implications of this increase led us to survey this consumption in the various hospital units. Our study proposes to measure the annual antibiotic use and antimicrobial resistance in an intensive care burn department in order to direct the control measures. During a 5-year period from 1 January 2000 to 31 December 2004 we studied the consumption of the following antibiotics: oxacillin, imipenem, ceftazidime, ofloxacin, ciprofloxacin, vacomycin. We measured antibiotic consumption with the antimicrobial density (AD), which takes into account the quantity of antibiotics in grams converted to the defined daily dose (DDD) and the number of days of hospitalization. The DDD was proposed by the World Health Organisation. The calculation of the AD for each molecule was carried out according to the following formula: AD = (quantity consumed [g] for the particular antimicrobial × 1000) / (DDD for that antimicrobial × number of days hospitalized). The study of the total consumption of antibiotics showed a peak in 2002. The distribution by families of antibiotics shows variations according to various molecules. Among oxacillin, a significant decrease in the consumption of this molecule was observed in 2004 (AD = 44 in 2004 vs AD = 128.2 in 2002). At the same time, a significant increase in the consumption of vancomycin (AD = 28.15 in 2002 vs 73.9 into 2004) was also observed. This intensive use of vancomycin was explained by the high incidence of the methicillin-resistant Staphylococcus aureus in our burn department (MRSA = 64% in 2004). As elsewhere, no vancomycin intermediate S. aureus was detected during the period of study, in spite of the significant use of this antibiotic. There were statistically significant relationships between increasing use of ceftazidime and ceftazidime-resistant Klebsiella pneumoniae (rs = 0.93, P = 0.02). Concerning the fluoroquinolones, there were statistically significant relationships between increasing use of ciprofloxacin and incidence of resistant P. aeruginosa to this antibiotic (rs = 0.89, P = 0.043). In addition to the resistance to the drug itself, the consumption of ciprofloxacin was significantly associated with resistance to the imipeneme in P. aeruginosa (rs = 0.87 P = 0.05). A restriction of the use of ciprofloxacin was taken during 2003 and 2004; this was followed by a significant decrease of resistance in P. aeruginosa. The use of fluoroquinolones was not significantly associated with MRSA (rs = 0.70, P = 0.1). The monitoring of both antibiotic consumption and antibiotic resistance makes it possible to set up targeted policies and to control their effectiveness. Nevertheless this monitoring must be integrated into a policy of good use and control of antibiotic use.
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- 2006
22. [Untitled]
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M Memi, A Bayoudh, K. Bousselmi, A. Messaadi, and L. Thabet
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medicine.medical_specialty ,Imipenem ,business.industry ,medicine.drug_class ,Antibiotics ,Ceftazidime ,Critical Care and Intensive Care Medicine ,Antimicrobial ,Ciprofloxacin ,Antibiotic resistance ,Amikacin ,Internal medicine ,Intensive care ,medicine ,Intensive care medicine ,business ,medicine.drug - Abstract
Increasing resistance in P. aeruginosa to multiple antibiotics has been observed and is posing therapeutic dilemmas. Antibiotic utilization is one factor that has been associated with the emergence of antimicrobial resistance. We examined the relationships between annual antibiotic use and the incidence of resistance of P. aeruginosa isolates within the burned patients admitted to our intensive care department in order to direct measurements of control. During a 5-year period (1 January 2000-31 December 2004), 203 nonrepetitive strains of P. aeruginosa were isolated from different specimens. Antimicrobial susceptibility testing has been carried out by the disk diffusion method according to the French Society of Microbiology. We studied the consumption of the following antibiotics: imipenem, ceftazidime, ciprofloxacin and amikacin. We measured antibiotic consumption with the antimicrobial density (AD), which takes into account the quantity of antibiotics in grams converted to daily doses dispensed and the number of patient-days in hospital. The defined daily dose was defined according to the World Health Organisation. Statistical analysis was conducted to explore the relationships between antibiotic use and the susceptibility patterns of P. aeruginosa. SPSS software was used to calculate the Spearman rank correlation coefficient. Statistical significance was defined as P < 0.05 for the corresponding correlation coefficients. The consumption of ceftazidime showed no association with resistance to this drug. There were statistically significant relationships between increasing use of ciprofloxacin and incidence of resistant P. aeruginosa to this antibiotic (rs = 0.89, P = 0.05). In addition to the association between ciprofloxacin use and resistance to the drug itself, our study revealed a significant correlation between ciprofloxacin consumption and resistance to imipeneme (rs = 0.89, P = 0.043). A restriction of the use of ciprofloxacin was taken during 2003 and 2004; this was followed by a significant decrease of incidence of resistance in P. aeruginosa. The consumption of amikacin had no apparent association with resistance in P. aeruginosa to this drug. Our data support a major role for ciprofloxacin in the emergence of multiresistance in P. aeruginosa. The use and/or duration of treatment with this antibiotic should be restricted as part of efforts to control the emergence of multidrug-resistant P. aeruginosa.
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- 2006
23. [DISTRIBUTION OF CARBAPENEMASES IN TUNISIAN BURN PATIENTS].
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Mokline A, Zarrouk S, Jemi I, Fraj H, Gasri B, Ben Saad M, Thabet L, and Messadi AA
- Abstract
Resistance to carpabenems in burns is rapidly spreading in many countries. Therefore identification of carbapenemase pathogen carriers is imperative in order to establish adequate infection control precautions and stop outbreaks of these multidrug-resistant bacteria. The aim of our study was to evaluate the distribution of carbapenemase producers in burn patients admitted to a burn center in Tunisia over 9 months. PCR for carbapenemase portage was performed in all patients within 48 hours of admission. Seventeen patients carried a single carbapenemase, 11 carried two, and 25 carried three. The enzymes detected were VIM (n=41), NDM (n=41) and OXA48 (n=32). Enzyme mapping revealed two main areas of carriage in central western Tunisia: Kairouan (NDM/OXA48) and Kasserine (NDM/VIM). Predictive factors for carriage of carbapenemase were: prior antibiotic therapy (n=24); mechanical ventilation (n=30); vascular catheterization (n=31) and a previous stay in intensive care (n=11)., (© 2024 Euro-Mediterranean Council for Burns and Fire Disasters.)
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- 2024
24. Co-occurrence of blaNDM-1 and blaOXA-23 in carbapenemase-producing Acinetobacter baumannii belonging to high-risk lineages isolated from burn patients in Tunisia.
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Raddaoui A, Mabrouk A, Chebbi Y, Frigui S, Salah Abbassi M, Achour W, and Thabet L
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- Humans, Tunisia epidemiology, Microbial Sensitivity Tests, beta-Lactamases genetics, Bacterial Proteins genetics, Multilocus Sequence Typing, Anti-Bacterial Agents pharmacology, Acinetobacter baumannii genetics
- Abstract
Aims: Carbapenem-resistant Acinetobacter baumannii (CR-Ab) is an important cause of infections in burn patients. This study aimed to characterize the antimicrobial susceptibility pattern of CR-Ab isolated from burns in Burn Intensive Care Unit (BICU) of the Trauma and Burn Centre of Ben Arous, to determine the prevalence of β-lactamase-encoding genes and to search eventual genetic relatedness of CR-Ab strains., Methods and Results: From 15 December 2016 to 2 April 2017, all nonduplicated CR-Ab isolated in burn patients in the BICU were screened by simplex Polymerase Chain Reaction (PCR) for the class A, B, C, and D β-lactamase genes. Sequencing was performed for NDM gene only. Genetic relatedness was determined by using pulsed field gel electrophoresis (PFGE) and by multilocus sequence typing. During the study period, 34 strains of CR-Ab were isolated in burns, mainly in blood culture (n = 14) and central vascular catheter (n = 10). CR-Ab strains were susceptible to colistin but resistant to amikacin (91%), ciprofloxacin (100%), rifampicin (97%), and trimethoprim-sulfamethoxazole (100%). All strains harbored blaOXA-51-like and blaOXA-23 genes, only or associated to blaGES (n = 26; 76%), blaADC (n = 20; 59%), blaPER-1 (n = 6; 18%) or/and blaNDM-1 (n = 3; 9%). PFGE identified 16 different clusters and revealed that most strains belonged to one major cluster A (n = 15; 44.1%). Among NDM-1 isolates, two were clonally related in PFGE and belonged to two single locus variant sequence type ST-6 and ST-85., Conclusions: This is the first description of clonally related NDM-1 and OXA-23-producing A. baumannii strains in the largest Tunisian BICU associated with two single locus variant sequence types ST6 and ST85., (© The Author(s) 2024. Published by Oxford University Press on behalf of Applied Microbiology International.)
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- 2024
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25. [32nd National STPI Congress 2nd French-speaking Congress of Infectious Pathology and Clinical Microbiology 5 to 7 May 2023, Hammamet, Tunisia].
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Toumi A, Ben Brahim H, Berriche A, Hachfi W, Marrakchi C, Ammari L, Ben Lasfar N, Koubaa M, Aoun K, Neji S, Ben Abdallah R, Bouchekoua M, Mhalla S, Naïja H, Gargouri S, Hannachi N, Thabet L, Mnif B, Achour W, Marzouk M, Boutiba I, and Chippaux JP
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- Humans, Tunisia epidemiology, Communicable Diseases
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- 2023
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26. Detection of carbapenem resistant Pseudomonas aeruginosa co-harboring blaVIM-2 and blaGES-5 in burn patients.
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Hmissi S, Raddaoui A, Frigui S, Abbassi MS, Achour W, Chebbi Y, and Thabet L
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- Humans, Bacterial Proteins genetics, beta-Lactamases genetics, Carbapenems pharmacology, Microbial Sensitivity Tests, Pseudomonas aeruginosa genetics, Retrospective Studies, Burns complications, Burns microbiology, Anti-Bacterial Agents pharmacology, Pseudomonas Infections epidemiology
- Abstract
Pseudomonas aeruginosa is one of the major infectious agents in burn patients. Globally, high rates of antimicrobial resistance in P. aeruginosa have been reported, which is a cause of concern. The objective of this study was to determine the rate of resistance to carbapenems in P. aeruginosa isolates recovered from burn patients in Tunisia, to search genes encoding for carbapenemases and to determine their epidemiological markers (serotypes). A retrospective study was conducted in the Burn Intensive Care Unit (BICU) of the Trauma and Burn Centre of Ben Arous, Tunisia, and P. aeruginosa isolates collected from burn patients, from January to December 2018 were investigated. Carbapenemase screening was performed by Carbapenem Inactivation Method (CIM) and by EDTA-disk test for all carbapenem resistant isolates. Genes encoding carbapenemases (blaVIM, blaIMP, blaGES, blaNDM, and blaKPC) were investigated by PCR and selected carbapenemase genes were sequenced. During the study period, 104 non duplicated P. aeruginosa isolates were recovered. Most of them were isolated from skin samples (45.1%) and blood culture (22.1%) and belonged to O:11 (19.2%), O:12, and O:5 (12.5%, each) serotypes. High rates of resistance were observed for carbapenems (64.4%). Among the 67 carbapenem resistant isolates, 58 (86.5%) harbored blaVIM gene and 55 (82%) blaGES gene; in addition, 48 (71.6%) co-harbored blaVIM and blaGES genes. After sequencing, the blaVIM-2 and blaGES-5 gene variants were identified in seven randomly selected isolates. To the best of our knowledge, this is the first description of P. aeruginosa simultaneously harboring blaVIM-2 and blaGES-5 genes.
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- 2023
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27. [Procalcitonin: The Ideal Biomarker To Guide Initiation, Change and Withdrawal of Antibiotics in Septic Burn Patients?]
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Mokline A, Sboui S, Fredj H, Ben Saad M, Eljemi I, Gasri B, Thabet L, and Messadi AA
- Abstract
The goal of this study was to assess plasma procalcitonin (PCT) concentrations during infectious events of burns in the ICU. We conducted a prospective, observational study in a 20-bed Burn Intensive Care Unit in Tunisia. A total of 120 septic patients admitted to the Burn ICU were included in our study. Sepsis was assumed according to the French Burn Association criteria for the presence of infection. Serum PCT was measured over the entire septic episode every 48 hours until resolution of infection, based on clinical signs and decrease of PCT of about 80% compared to its initial value. Patients were assigned to two groups depending on clinical course and outcome: Group A = patients with favourable evolution; Group B = patients with unfavourable evolution. Monitoring of kinetics of PCT allowed us to judge the effectiveness of the initial antibiotic therapy, with a threshold of 43.5% decrease at day 3 of treatment, with a better sensitivity and specificity of 79.6% and 87.7% respectively. In addition, PCT monitoring allowed a reduction in the duration of antibiotic therapy of 5±2.8 days versus 8 to 10 days before the use of PCT., (© 2023 Euro-Mediterranean Council for Burns and Fire Disasters.)
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- 2023
28. Methicillin-Resistant Staphylococcus aureus Strains Isolated from Burned Patients in a Tunisian Hospital: Molecular Typing, Virulence Genes, and Antimicrobial Resistance.
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Kmiha S, Jouini A, Zerriaa N, Hamrouni S, Thabet L, and Maaroufi A
- Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major causes of a variety of infections in hospitals and the community. Their spread poses a serious public health problem worldwide. Nevertheless, in Tunisia and other African countries, very little molecular typing data on MRSA strains is currently available. In our study, a total of 64 MRSA isolates were isolated from clinical samples collected from burned patients hospitalized in the Traumatology and Burns Center of Ben Arous in Tunisia. The identification of the collection was based on conventional methods (phenotypic and molecular characterization). The characterization of the genetic support for methicillin resistance was performed by amplification of the mecA gene by polymerase chain reaction (PCR), which revealed that 78.12% of S. aureus harbors the gene. The resistance of all the collection to different antibiotic families was studied. Indeed, the analysis of strain antibiotic susceptibility confirmed their multi-resistant phenotype, with high resistance to ciprofloxacin, gentamicin, penicillin, erythromycin, and tetracycline. The resistance to the last three antibiotics was conferred by the blaZ gene (73.43%), the erm ( C ) gene (1.56%), the msr ( A ) gene (6.25%), and tet ( M ) gene (7.81%), respectively. The clonal diversity of these strains was studied by molecular typing of the accessory gene regulator ( agr ) system, characterization of the SCC mec type, and spa -typing. The results revealed the prevalence of agr types II and III groups, the SCC mec type III and II cassettes, and the dominance of spa type t233. The characterization of the eight enterotoxins genes, the Panton-Valentine leukocidin and the toxic shock syndrome toxin, was determined by PCR. The percentage of virulence genes detected was for enterotoxins (55%), tst (71.88%), leukocidin E/D (79.69%), and pvl (1.56%) factors. Furthermore, our results revealed that the majority of the strains harbor IEC complex genes (94%) with different types. Our findings highlighted the emergence of MRSA strains with a wide variety of toxins, leukocidin associated with resistance genes, and specific genetic determinants, which could constitute a risk of their spread in hospitals and the environment and complicate infection treatment.
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- 2023
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29. Widespread of the Vienna/Hungarian/Brazilian CC8-ST239-SCCmec III MRSA clone in patients hospitalized in the Tunisian Burn and Traumatology Center.
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Ben Said M, Thabet L, Cheriet S, Messadi AA, Gómez P, Ruiz-Ripa L, Sghaier S, Hassen B, Hassen A, Torres C, and Abbassi MS
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- Humans, Molecular Typing, Molecular Epidemiology, Brazil, Hungary, Genotype, Microbial Sensitivity Tests, Anti-Bacterial Agents, Methicillin-Resistant Staphylococcus aureus genetics, Staphylococcal Infections, Traumatology, Burns
- Abstract
The emergence and spread of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals is a major global public health concern. The current study sought to characterize 25 MRSA clinical isolates collected in a Tunisian hospital from December 2015 to September 2016, with the genetic lineages, virulence factors, and antibiotic resistance mechanisms determined for these isolates. Three spa-types were detected: t037 (23 isolates), t932, and t2235 (one isolate each). Isolates were ascribed to agr I (n = 20), agr II (n = 1), with four nontypeable isolates. Depending on sequence type (ST), the 25 MRSA isolates were assigned to two clonal complexes (CC8 and CC5), with a predominance of the lineage ST239-CC8 (n = 24; 96%). All isolates belonging to CC8 had the SCCmec type III, while the unique CC5 isolate had SCCmec type IV. Antimicrobial susceptibility testing revealed high levels of resistance to aminoglycosides, tetracycline, ciprofloxacin and rifampicin for the majority of isolates belonging to the ST239-CC8 lineage. The ST149-CC5 isolate was susceptible to non-β-lactam antibiotics. One isolate harbored the tsst-1 gene (4%); however, lukS/LukF-PV, eta and etb genes were not detected. The MDR ST239-CC8 clone would seem to be widespread in this hospital. Therefore, a rigorous hygienic control system is urgently required., (© The Author(s) 2022. Published by Oxford University Press on behalf of Applied Microbiology International.)
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- 2023
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30. Dissemination of epidemic ST239/ST241-t037-agrI-SCCmecIII methicillin-resistant Staphylococcus aureus in a Tunisian trauma burn intensive care unit.
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Raddaoui A, Chebbi Y, Bouchami O, Frigui S, Messadi AA, Achour W, and Thabet L
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- Humans, Staphylococcus aureus genetics, Genotype, Microbial Sensitivity Tests, Anti-Bacterial Agents, Tetracycline, Intensive Care Units, Methicillin-Resistant Staphylococcus aureus genetics, Staphylococcal Infections epidemiology
- Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen causing health care-infections in the world, especially in burns. The aim of this study was to assess the extent of dissemination of MRSA isolated from burn patients in Burn Intensive Care Unit in Tunisia and to evaluate the frequency of virulence and antibiotics resistance genes. Among the 72 S. aureus isolates analyzed in the study, 54% were MRSA. The majority of MRSA (94.8%) were multidrug resistant and they had a high resistance rates to kanamycin (94.8%), tobramycin (90%), tetracycline (94.8%) and ciprofloxacin and rifampicin (87%, each). The gene aac(6')-Ie-aph(2″)-Ia conferring resistance to kanamycine and tobtamycin were detected in all isolates and the aph(3')-Ia gene conferring resistance to gentamicin were detected in 2.8% of resistant isolates. Tetracycline resistance genes tet(M), tet(K) and tet(L) were detected in 100%, 10.8% and 2.8% of the isolates, respectively. The SCCmec type III and the agr type I were the most predominant (69.2% and 90%, respectively). The 27 SCCmecIII-agrI isolates were clustered into two PFGE types A and B. The two representative isolates of PFGE clusters A and B belonged to ST239-t037 and ST241-t037 respectively. As conclusion, our results showed a high prevalence of MRSA in trauma burn intensive care unit belonging to two multidrug resistant clones ST239/ST241-agrI-t037-SCCmecIII MRSA. We also demonstrated that MRSA was disseminated between burn patients.
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- 2022
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31. Corrélation Entre La Consommation D’Antibiotiques Et Les Taux D’Antibiorésistance Chez P. Æruginosa Dans Un Service De Réanimation Des Brûlés Tunisien: Étude Sur 6 Ans (2014-2019).
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Thabet L, Frigui S, Mellouli A, Gargouri M, Maamar B, Harzallal I, Boukadida J, and Messadi AA
- Abstract
Antibiotics are one of the greatest advances in modern medicine. Antibiotic resistance is one of the most serious threats to global health, aggravating the prognosis of immunocompromised patients, especially burn patients. Our objective was to study the consumption of antibiotics of critical importance according to the WHO and the correlation between antibiotic resistance in Pseudomonas æruginosa and the consumption of these antibiotics. Our study took place in the Medical Laboratory in collaboration with the Trauma and Burn Center's Burn Unit in Tunisia. In our retrospective study, 1384 non-repetitive strains of Pseudomonas æruginosa responsible for colonization or infection were included, between January 2012 and December 2019. Pseudomonas æruginosa was the most isolated bacterial strain in the service, with an average rate of 15.9% of the service's bacterial ecology. The antibiotic resistance rates tested were high: 77.1% to piperacillin-tazobactam, 56% to ceftazidime, 74.9% to imipenem, 78.8% to amikacin, 54.7% to ciprofloxacin and 32.8% to fosfomycin. Among our strains, 81.8% were multi drug-resistant strains. The analysis of the correlation between the level of consumption of antibiotics and the antibiotic resistance levels in Pseudomonas æruginosa showed that the increased consumption of piperacillin-tazobactam increased resistance not only to piperacillin-tazobactam but also to imipenem and amikacin as well as multi drug resistance. Similarly, the increase in the consumption of fosfomycin correlates with resistance to piperacillin-tazobactam and imipenem., (Copyright © 2021 Euro-Mediterranean Council for Burns and Fire Disasters.)
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- 2021
32. Colonisation Et Infection À Acinetobacter Baumannii Dans Une Unité De Réanimation Des Brûlés En Tunisie.
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Mellouli A, Maamar B, Bouzakoura F, Messadi AA, and Thabet L
- Abstract
Acinetobacter baumannii is a feared pathogen in the burn center due to its opportunistic nature and its multidrug resistance. Our purpose was to study the incidence density of Acinetobacter baumannii colonization and infection and to determine the antibiotic susceptibility of the strains isolated in patients hospitalized in the Trauma and Burn Center Burn Unit in Tunisia. Our retrospective study included 1517 non-repetitive strains of Acinetobacter baumannii, between January 2012 and September 2020, with an average rate of 12.2% of the service's bacterial ecology. The incidence density of Acinetobacter baumannii colonization and infection was 13.7‰ days of in-patient stay and 14.1‰ days of in-patient stay, respectively. A positive and statistically significant correlation between Acinetobacter baumannii colonization and infection (rs=0,7; p=0.005) was noted in our study. The colonization strains were mainly isolated from central catheters (71.2%) and skin swab samples (22.9%). Infections were dominated by bacteremia (47.6%) and respiratory tract infections (25.4%). Bacteremia was microbiologically documented in 53% of cases. The most common source of bacteremia was central catheters (60.8%), skin (22.2%) and respiratory tract (15.5%). The rates of resistance inAcinetobacter baumannii to the antimicrobial agents tested were high: ceftazidime (85.2%), pipéracillin-tazobactam (95.6%), imipenem (95.3%), amikacine (91.1%), ciprofloxacin (93.5%), rifampicin (36.4%) and cotrimoxazole (88.1%). The resistance of colistin was noted in 1.8% of cases., (Copyright © 2021 Euro-Mediterranean Council for Burns and Fire Disasters.)
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- 2021
33. Hypernatremia Risk Factors And Prognostic Impact In Burn Patients: A Case Control Study.
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Sedghiani I, Mokline A, Fredj H, Bouguezzi N, Gamara FZ, Ben Saad M, Thabet L, and Messadi AA
- Abstract
Hypernatremia is associated with poor outcomes in critically ill patients. Hypernatremia risk factors in burned patients are not well studied. We aimed to identify hypernatremia risk factors and to evaluate outcomes in burned patients admitted to our burns intensive care unit. A case control study was conducted in adult burned patients hospitalized between January 1st 2017 and December 31st 2019. Cases who developed hypernatremia (>145 meq/L) during hospitalization were matched 1:1 with controls based on age and total burn surface area. There were 57 cases and 57 controls with a mean age of 41 ± 18 years. The majority of patients had major burns (n=99, 86.8%). The time onset of hypernatremia was seven days post burn. Compared to controls, the case group mostly consisted of transferred patients with longer time from injury to intensive care unit admission. Inhalation injury, mechanical ventilation, intravenous fosfomycin and colistin were associated with hypernatremia. Admission to the intensive care unit after six hours post-burn was the independent risk factor (OR=4.5). Hypernatremia was associated with longer length of stay and with higher mortality. We conclude that delayed management, inhalation injury, mechanical ventilation, fosfomycin and colistin administration are the main hypernatremia risk factors in burned patients., (Copyright © 2021 Euro-Mediterranean Council for Burns and Fire Disasters.)
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- 2021
34. Bactériémies Nosocomiales: Épidémiologie Clinique Et Bactériologique Chez Les Brûlés.
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Frigui S, Bourbiaa Y, Mokline A, Naija H, Messadi AA, and Thabet L
- Abstract
Nosocomial bacteremia (NB) is one of the most severe infections in burns in intensive care units. Their prognosis is worsened with the emergence and spread of multidrug resistant bacteria (MDR). Our retrospective study aimed to investigate clinical and bacteriological characteristics of NB occurring in patients hospitalized in the Trauma and Burn Center's Burn Unit (TBC-BU) in Tunisia, during a 3-year period (2016-2018). We found 261 NB in 216 patients, for a prevalence of 25.7% and an incidence density of 13.4‰ days of in-patient stay. The vast majority (88.9%) of NB occurred during the first 2 weeks of hospitalization. The catheterrelated bacteremia rate was 11.1%. P. æruginosa (20.2%) and A. baumannii (16.8%) were the 2 species most frequently isolated when S. aureus represented only 7.5% of isolates. Resistance rates were high, with 71% of P. æruginosa resistant to ceftazidime, 64% of S. aureus being MRSA, 69,5% of resistance to 3rd generation cephalosporins among Enterobacteriaceae, and colimycin remaining the only regularly active antibiotic (98%) on A. baumannii. The MDR rate was 44%, represented mainly by A. baumannii, ESBL-E and P. æruginosa. The mortality rate due to NB was 25%, with a significantly higher rate of MDR in fatal NB compared to that in NB with favorable outcome (p = 0,000019)., (Copyright © 2021 Euro-Mediterranean Council for Burns and Fire Disasters.)
- Published
- 2021
35. Colonisation Et Infection À Pseudomonas Æruginosa Dans Un Service De Réanimation Des Brûlés: Étude Sur 8 Ans.
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Frigui S, Messadi AA, and Thabet L
- Abstract
Pseudomonas æruginosa (PA) is among the major agents of infection in burns. Multidrug-resistant strains are commonly isolated, which hampers the management of these patients. Our purpose was to study the incidence density of PA colonization and PA infection and to investigate the antibiotic susceptibility of strains isolated in patients hospitalized in the Trauma and Burn Center's Burn Unit (TBC-BU) in Tunisia. It is a retrospective study including 1649 non-repetitive strains of PA during an 8-year period (2012- 2019). PA was the most common organism in TBC-BU bacterial ecology (15%). The incidence density of PA colonization and PA infection was 16.1‰ days of in-patient stay (DH) and 16.5‰ DH, respectively. A positive and statistically significant correlation was found between PA colonization and PA infection (rs=1; p=0,004). The colonization strains were mainly isolated from skin (25.1%) and central catheters (22.3%). Bacteremia was the most common infection (19.5%). The skin was the most common source of bacteremia (22.1%) followed by central catheters (18.3%). The highest rates of antibiotic resistance were found with piperacillin-tazobactam (72.4%), ceftazidime (49.4%), meropenem (74%), imipenem (70.5%), amikacin (74.6%), ciprofloxacin (56.5%) and fosfomycin (35.3%). We did not identify any colistin-resistant strain. The multidrug resistance rate was 78%. The metallo-carbapenemase-producing strains rate was 14.4%., (Copyright © 2020 Euro-Mediterranean Council for Burns and Fire Disasters.)
- Published
- 2020
36. Clonal spread of PER-1 and OXA-23 producing extensively drug resistant Acinetobacter baumannii during an outbreak in a burn intensive care unit in Tunisia.
- Author
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Mabrouk A, Chebbi Y, Raddaoui A, Krir A, Messadi AA, Achour W, and Thabet L
- Subjects
- Acinetobacter Infections epidemiology, Acinetobacter baumannii drug effects, Acinetobacter baumannii enzymology, Acinetobacter baumannii isolation & purification, Anti-Bacterial Agents pharmacology, Bacterial Proteins biosynthesis, Bacterial Proteins genetics, Colistin pharmacology, Cross Infection epidemiology, Disease Outbreaks, Genes, Bacterial, Humans, Tunisia epidemiology, beta-Lactamases genetics, Acinetobacter Infections microbiology, Acinetobacter baumannii genetics, Burn Units, Cross Infection microbiology, Drug Resistance, Multiple, Bacterial genetics, beta-Lactamases biosynthesis
- Abstract
Extensively drug resistant Acinetobacter baumannii (XDR-Ab), has emerged as an important pathogen in several outbreaks. The aim of our study was to investigate the eventual genetic relatedness of XDR-Ab strains recovered from burn patients and environment sites in the largest Tunisian Burn Intensive Care Unit (BICU) and to characterize β-lactamase encoding genes in these strains. Between March 04th, 2019 and April 22nd, 2019 an outbreak of XDR-Ab was suspected. Environmental screening was done. All isolates were screened by simplex PCR for β-lactamase genes. Genetic relatedness was determined by pulsed field gel electrophoresis (PFGE) of ApaI-digested total DNA. During the study period, 21 strains of A. baumannii were isolated in burn patients, mainly in blood culture (n = 7) and central vascular catheter (n = 6). All strains were susceptible to colistin but resistant to imipenem (n = 23), ciprofloxacin (n = 23), amikacin (n = 22), tigecyclin (n = 5) and rifampicin (n = 4). The blaOXA-51-like, blaOXA23, and blaADC genes were present in all strains. These resistance determinants were associated with blaPER-1 in 10 strains. The ISAba1 was inserted upstream of blaOXA-23 in all isolates. PFGE revealed two major clusters A (n = 11) and B (n = 5). This is the first description in Tunisia of clonally related PER-1 producing XDR-Ab in burn patients with probable environmental origin.
- Published
- 2020
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37. Molecular profile of carbapenemase-producing Enterobacterales in burn patients.
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Mellouli A, Jaoua MA, Dhraief S, Messadi AA, and Thabet L
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- Anti-Bacterial Agents pharmacology, Bacterial Proteins, Humans, Microbial Sensitivity Tests, Retrospective Studies, beta-Lactamases, Burns microbiology, Drug Resistance, Bacterial, Escherichia coli drug effects
- Abstract
Background: Carbapenemase-producing Enterobacterales (CPE) present a threat to public health worldwide., Aim: To study their prevalence at the Trauma and Burn Center's Burn Unit and investigate their molecular characteristics and their associated antibiotics resistance patterns., Methods: This is a retrospective study conducted at the Trauma and Burn Center's laboratory between july 2017 and december 2018. It included all patients hospitalized in the Trauma and Burn Center's Burn Unit infected with Enterobacterales resistant to carbapenems. The search of the carbapenemases genes was performed by PCR amplification GeneXpert® IV (Cepheid, Sunnyvale, CA, USA) by Xpert® Carba-R kit., Results: During the study period, among 574 Enterobacterales, 64 strains (11.1%) were resistant to carbapenems, 58 strains (90.6%) of which were CPE. K. pneumoniae was the most predominant bacteria (n=50) fllowed by E. cloacae (n=7), P. mirabilis (n=3), E. aerogenes (n=2), E. coli (n=1) and P. rettgeri (n=1). The most common carbapenemase gene was blaNDM gene (58.6%) followed by blaOXA48 (24.1%). The co-existence of these two genes was identified in ten strains (17.3%). For the 58 CPE, resistance to ertapenem, imipenem and meropenem was 100%, 18.4% and 36.2%, respectively. The highest resistance rates were found to third-generation-cephalosporins (100%), ciprofloxacin (95%) and gentamicin (89.7%). Fosfomycin and colistin had the best susceptibility in vitro with only 5.2% and 4.8% of resistance, respectively., Conclusion: The high prevalence of CPE in our center requires continued screening and reinforcement of hygiene measures.
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- 2020
38. Rapid diagnostic tests : Pros, cons and potential use in the COVID-19 management in Tunisia.
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Jameleddine Chtioui M, Grati H, Harzallah N, Odabachian Jebali MC, Trabelsi A, Ben Ahmed M, Thabet L, Mhalla S, Ben Moussa M, Messaoud T, Ben Romdhane H, Toumi A, and Hamouda C
- Subjects
- Humans, Time Factors, Tunisia, COVID-19 diagnosis, COVID-19 Testing methods
- Abstract
Objectives: Diagnosis of SARS-CoV-2 infection is a major public health issue. In a context of limited diagnostic capacity with the reference technique (real-time RT-PCR), many manufacturers have developed rapid diagnostic tests (RDTs). Although very promising in theory, these tests have raised many questions. This article is a rapid review that synthesizes data regarding different types of available RDTs, their performance, their limits and their potential indications in Tunisia as proposed by a multidisciplinary group of experts., Methods: A literature review was carried out on the websites of international organizations, governmental bodies and on INAHTA database, completed by a search of relevant scientific articles up to 1 June 2020. The synthesis of the data was submitted to a panel of experts to propose recommendations for the Tunisian context., Results: RDTs based on the detection of antigens and antibodies have sensitivity and specificity related issues. Few validation reports are published in the scientific literature. Pending more evidence on their performance and validity, several international organizations recommend their use only for research purposes. TDRs based on antibody detection are not appropriate for the early diagnosis of COVID-19. However, validated and specific tests could provide complementary diagnostic information to reference tests., Conclusion: Pending further evidence, the panel recommends the use of RDTs mainly for research purposes at the community level.
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- 2020
39. SARS-CoV-2 infection virological diagnosis.
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Thabet L, Mhalla S, Naija H, Jaoua MA, Hannachi N, Fki-Berrajah L, Toumi A, and Karray-Hakim H
- Subjects
- COVID-19, Coronavirus Infections virology, Humans, Pandemics, Pneumonia, Viral virology, Real-Time Polymerase Chain Reaction, Reproducibility of Results, SARS-CoV-2, Sensitivity and Specificity, Betacoronavirus genetics, Coronavirus Infections diagnosis, Pneumonia, Viral diagnosis
- Abstract
SARS-CoV-2 infection has to be confirmed by virological diagnosis. Multiple diagnostic tests are available without enough perspective on their reliability. Therefore, it is important to choose the most suitable test according to its sensitivity and specificity but also to the stage of the disease. Currently, the RT-PCR detection of the viral genome in respiratory samples is the most reliable test to confirm the diagnosis of an acute SARS-CoV-2 infection. It has to be done in Class II biological safety laboratory. However, it may lack sensitivity, particularly in the advanced phase of infection, and depends closely on the samples' quality. Rapid PCR by cartridge system reduces response times but is not suitable for laboratories with high throughput of requests. Detection of virus antigens on respiratory samples is a quick and easy to use technique; however it has not good specificity and sensitivity and cannot be used for diagnosis and patient management. The detection of specific antibodies against SARS-CoV-2 is better used for epidemiological analyses. Research should be encouraged to overcome the limits of the currently available diagnostic tests.
- Published
- 2020
40. Profil bactériologique et résistance aux antibiotiques des bactéries isolées dans un service de réanimation des brûlés durant sept ans.
- Author
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Krir A, Dhraief S, Messadi AA, and Thabet L
- Abstract
This study was retrospective, conducted over seven years at the Trauma and Burn Centre. Its purpose was to establish the bacteriological profile and antibiotic resistance of isolated bacteria in patients admitted to the Burn Intensive Care Unit. Identification was carried out according to the conventional methods and antibiotic susceptibility was analyzed according to the standards of the Antibiogram Committee of the French Society of Microbiology. Pseudomonas aeruginosa was the main isolated bacterium, followed by Staphylococcus aureus, Klebsiella pneumoniae and Acinetobacter baumannii. These strains were isolated mainly from haemocultures (37%). The resistance of Pseudomonas aeruginosa to ceftazidime increased from 9.2% in 2012 to 53.5% in 2018. The resistance to imipenem and ciprofloxacin was 63.3% and 42.9%, respectively. Four strains were resistant to colistin. The resistance of S. aureus to meticillin decreased from 65.3% in 2012 to 41.6% in 2018. All strains were susceptible to glycopeptides, tigecycline and linezolid. A. baumannii was multi-resistant to antibiotics with 81.8% resistance to ceftazidime, 88.9% to amikacin, 90.5% to ciprofloxacin and 94.5% to imipenem. Sixteen strains were resistant to colistin. Concerning K. pneumoniae, 77.5% of strains were resistant to cefotaxime and 5.2% to imipenem. Two strains were resistant to colistin. Vancomycin resistance in Enterococcus faecium increased from 33.4% in 2012 to 72.2% in 2018. Multidrug resistance in burn patients calls for an epidemiological surveillance of bacterial ecology and the application of hygiene measures., (Copyright © 2019 Euro-Mediterranean Council for Burns and Fire Disasters.)
- Published
- 2019
41. Profil moléculaire et résistance aux antibiotiques des entérobactéries productrices de carbapénèmases chez le brûlé.
- Author
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Maamar B, Messadi AA, and Thabet L
- Abstract
Carbapenemase-producing Enterobacteriaceae (CPE) pose an emerging threat worldwide. The purpose of our work was to determine their prevalence among patients hospitalized in the Trauma and Burn Centre's Burn Unit, and to study their microbiological and molecular characteristics. Our study was longitudinal, conducted at the Trauma and Burn Centre's laboratory between January and June 2017. It focused on 42 CPE strains isolated from 34 patients. These strains were made up of K. pneumoniae (24), P. mirabilis (13), K. oxytoca (2), P. stuartii (1), E. coli (1), and E. cloacae (1). The overall prevalence of CPE among Enterobacteriaceae was 14.43% with a monthly decline. The blaNMD gene (59%) predominated on blaOXA-48 (33%) and 7% of strains co-expressed these two genes. We describe the first case of P. stuartii carrying blaNDM in Tunisia. Resistance to ertapenem, imipenem and meropenem was 83%, 57%, and 10% respectively. The antibiotics showing the highest resistant rates were third-generation cephalosporins (97%), gentamicin (98%) and norfloxacin (90%). Colistin and fosfomycin had the best-preserved activity in vitro with 4% and 33% resistance, respectively. The prevalence of EPCs is high among burns. Screening efforts, hygiene measures and the preservation of the few molecules still active are a vital issue., (Copyright © 2019 Euro-Mediterranean Council for Burns and Fire Disasters.)
- Published
- 2019
42. Étude épidémio-clinique des infections à entérobactéries productrices de carbapénémases chez les brûlés.
- Author
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Maamar B, Abdelmalek R, Messadi AA, and Thabet L
- Abstract
This study was longitudinal, conducted at the Trauma and Burn Centre between January and June 2017. Its purpose was to determine the prevalence of CPE infection among patients admitted to the Burn Intensive Care Unit, and to study their clinical and biological characteristics. Molecular typing of carbapenemases was performed with PCR type GeneXpert. Thirteen patients were infected with 7 episodes of bacteremia, 2 had ventilator acquired pneumonia and 4 catheter infections, with a prevalence of 7% of admissions. The average length of stay in the intensive care unit prior to infection was 12 days. Antibiotic exposure involved 12 of the 13 patients: 9 patients were transferred from other intensive care units. Thirteen and ten patients were respectively exposed to central catheterization and mechanical ventilation. The predominant carbapenemase among the infecting carbapenemase-producing enterobacteriacae strains was NDM carbapenemase (9/15), with a first description of P. stuartii carrying blaNDM strain in Tunisia. One patient died before adapting antibiotic therapy. For the others, 13 adapted bi-antibiotherapies were prescribed. There were five patient deaths from infection, four of whom had received appropriate antibiotic therapy. Imipenem was used each time the MIC was ≤4mg/l, in combination with another antibiotic: amikacin (3/8), colimycin (4/8), or tigecycline (1/8). Three of these prescriptions resulted in death. The prevalence of carbapenemase-producing enterobacterial infections is high among burn patients with a predominance of NDM-type carbapenemase.
- Published
- 2019
43. Description of an original integron encompassing blaVIM-2, qnrVC1 and genes encoding bacterial group II intron proteins in Pseudomonas aeruginosa.
- Author
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Belotti PT, Thabet L, Laffargue A, André C, Coulange-Mayonnove L, Arpin C, Messadi A, M'Zali F, Quentin C, and Dubois V
- Subjects
- Anti-Bacterial Agents pharmacology, Burn Units, Burns complications, Burns epidemiology, Conjugation, Genetic, Endemic Diseases, Gene Expression Profiling, Gene Transfer, Horizontal, Humans, Imipenem pharmacology, Introns, Molecular Sequence Data, Pseudomonas aeruginosa enzymology, Pseudomonas aeruginosa isolation & purification, Sequence Analysis, DNA, Transformation, Bacterial, Tunisia epidemiology, beta-Lactam Resistance, Genes, Bacterial, Integrons, Pseudomonas Infections microbiology, Pseudomonas aeruginosa genetics, beta-Lactamases genetics
- Abstract
Objectives: A burn unit of a hospital in Tunis underwent an endemic situation caused by imipenem-resistant Pseudomonas aeruginosa. For nine non-repetitive isolates of a clonal VIM-2-producing strain, the blaVIM-2 genetic background was characterized and the associated qnrVC1 gene molecularly analysed., Methods: The imipenem resistance mechanism was investigated by phenotypic and molecular tests, and resistance transfer was studied by conjugation and transformation experiments. The integron's structure was characterized by sequencing, and qnrVC1 expression was explored after cloning experiments., Results: The nine VIM-2-producing strains were collected from eight patients and one environmental sample. All transfer assays failed, suggesting a chromosomal location of blaVIM-2. This latter was found to be part of a class 1 integron of ∼7500 bp, which also contains blaOXA-2, aadA1 and two copies of the aadB, arr-6 and qnrVC1 genes. qnrVC1 exhibited higher homology with the chromosomally encoded qnr genes of Vibrionaceae than with plasmid-mediated qnr genes of Enterobacteriaceae. The qnrVC1 gene cassette possesses a promoter allowing its expression, and it conferred decreased fluoroquinolone susceptibility to Escherichia coli. Additionally, on the same integron, genes encoding an uncommon group IIC-attC intron were detected., Conclusions: A VIM-2-producing P. aeruginosa outbreak led us to characterize an integron harbouring a qnrVC1 cassette and a new group IIC-attC intron. This is the first known description of a qnr determinant in a P. aeruginosa strain. Its presence conferred a low level of resistance to quinolones in E. coli, which might favour the emergence of highly resistant mutants., (© The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2015
- Full Text
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44. [Comparative study of antibiotic resistance in bacteria isolated from burned patients during two periods (2005-2008, 2008-2011) and in two hospitals (Hospital Aziza Othmana, Trauma and Burn Center)].
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Thabet L, Zoghlami A, Boukadida J, Ghanem A, and Messadi AA
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- Humans, Tunisia, Bacteria isolation & purification, Burn Units, Drug Resistance, Bacterial
- Abstract
Background: Continuous monitoring of the bacterial flora and antibiotic resistance of the main bacteria involved in nosocomial infections helps improve treatment and prevention strategies., Aim: To compare the bacteriological profile and antibiotic susceptibility of the main bacterial isolates within the burned patients over two periods of 3 years and in two hospitals., Methods: During two three-year periods: period 1 (P1): 1/7/2005-30/6/2008 and period 2 (P2): 1/7/2008-30/6/2011) and in two hospitals: Hospital Aziza Othmana (HAO) and the traumatology and burn center (CTGB), 2153 and 3719 non-repetitive strains were isolated from burn patients from different samples. The transfer of the intensive care unit was made on 01/07/2008 from the Hospital Aziza Othmana to CTGB. The study of antibiotic sensitivity was performed according to CA-SFM., Results: During the period P1, Pseudomonas aeruginosa was the main bacteria isolated (18%) followed by Staphylococcus aureus (14%) and Acinetobacter baumannii (12%). After the transfer of intensive care burn unit to the traumatology center, ecology bacterial varied with S. aureus (20%) in the first place followed by P. aeruginosa (15%) and Proteus mirabilis (11%). The study of the evolution of antibiotic susceptibility showed an overall downward trend of resistance in the second half of 2008, immediately after the transfer of service in the new hospital structure. The rate of ceftazidim resistant Klebsilella pneumoniae decreased from 80.4% to 50%, Similarly the resistance of P. aeruginosa to ceftazidime and imipenem decreased respectively from 61% to 39.4% and from 63.3% to 37.1%. Nevertheless, the reduction of resistance was followed by a rapid increasing during the year 2009 to reach overall rates of resistance previously observed in the hospital Aziza Othmana. Concerning S. aureus, the rate of MRSA (methicillin-resistant S. aureus) showed no significant variation throughout the study period: 60% versus 56.3% at HAO and CTGB. A. baumannii brings up the problem of mutirésistance: 92.7% of strains were resistant to ceftazidime and 63.9% to imipenem during P1 with an emphasis on resistance to imipenem during P2 increased to 89.3%., Conclusion: Resistance is a problem in the intensive care burn unit. Preventive measures have to be taken.
- Published
- 2013
45. Epidemiological profile and antibiotic resistance of Pseudomonas aeruginosa isolates in burn and Traumatology center in Tunisia over a three-year period.
- Author
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Thabet L, Zoghlami A, Kanzari L, Boukadida J, Messadi AA, and Ghanem A
- Abstract
Background: Pseudomonas aeruginosa is a known opportunistic pathogen frequently causing serious infections in burned patients., Aim: To analyze the epidemiological profile of Pseudomonas aeruginosa isolated in a Tunisian burn unit., Methods: During a 3-year period (from 01 July 2008 to 30 June 2011), 544 non repetitive strains of P. aeruginosa were isolated from burn patients. Susceptibility to antibiotics was assessed according to CA-SFM guidelines. Serotypes were identified by slide agglutination test using P.aeruginosa O antisera (Biorad). Producing carbapenemase was analyzed for 202 imipenem resistant isolates by EDTAtest. Susceptibility testing data were stored in a laboratory data base using whonet 5.3 software., Results: The most frequent sites of isolation were cutaneous infections and blood cultures (83.4%). The percentages of resistant isolates were as follows: ceftazidime: 34%; imipenem: 37.1%, ciprofloxacin: 27.1% and amikacin: 29.6%. The most prevalent serotypes were: 011(51%), 06(17%), 03 (8%), 04(12%), 012(5%). Among the 202 imipenem resistant strains, 58% expressed a metallocarbapenemase. All theses strains were resistant to all tested antibiotics except colistin and belonged to the serotype O11., Conclusion: The dissemination of carbapenemases strains must be contained by implementation of timely identification, strict isolation methods and better hygienic procedures.
- Published
- 2012
46. Evolution of an incompatibility group IncA/C plasmid harboring blaCMY-16 and qnrA6 genes and its transfer through three clones of Providencia stuartii during a two-year outbreak in a Tunisian burn unit.
- Author
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Arpin C, Thabet L, Yassine H, Messadi AA, Boukadida J, Dubois V, Coulange-Mayonnove L, Andre C, and Quentin C
- Subjects
- Adolescent, Adult, Aged, Bacterial Typing Techniques, Burn Units, Cephalosporins administration & dosage, Child, DNA Restriction Enzymes metabolism, Enterobacteriaceae Infections drug therapy, Enterobacteriaceae Infections microbiology, Female, Gene Transfer, Horizontal, Gentamicins administration & dosage, Humans, Integrons genetics, Male, Middle Aged, Mutagenesis, Insertional, Plasmids, Providencia drug effects, Providencia isolation & purification, Sequence Deletion, Tunisia epidemiology, Anti-Bacterial Agents administration & dosage, Disease Outbreaks, Drug Resistance, Multiple, Bacterial genetics, Enterobacteriaceae Infections epidemiology, Providencia genetics, beta-Lactamases genetics
- Abstract
During a 2-year period in 2005 and 2006, 64 multidrug-resistant Providencia stuartii isolates, including 58 strains from 58 patients and 6 strains obtained from the same tracheal aspirator, were collected in a burn unit of a Tunisian hospital. They divided into four antibiotypes (ATB1 to ATB4) and three SmaI pulsotypes (PsA to PsC), including 49 strains belonging to clone PsA (48 of ATB1 and 1 of ATB4), 11 strains to clone PsB (7 of ATB2 and 4 of ATB3), and 4 strains to clone PsC (ATB3). All strains, except for the PsA/ATB4 isolate, were highly resistant to broad-spectrum cephalosporins due to the production of the plasmid-mediated CMY-16 β-lactamase. In addition, the 15 strains of ATB2 and ATB3 exhibited decreased quinolone susceptibility associated with QnrA6. Most strains (ATB1 and ATB3) were gentamicin resistant, related to an AAC(6')-Ib' enzyme. All these genes were located on a conjugative plasmid belonging to the incompatibility group IncA/C(2) of 195, 175, or 100 kb. Despite differences in size and in number of resistance determinants, they derived from the same plasmid, as demonstrated by similar profiles in plasmid restriction analysis and strictly homologous sequences of repAIncA/C(2), unusual antibiotic resistance genes (e.g., aphA-6), and their genetic environments. Further investigation suggested that deletions, acquisition of the ISCR1 insertion sequence, and integron cassette mobility accounted for these variations. Thus, this outbreak was due to both the spread of three clonal strains and the dissemination of a single IncA/C(2) plasmid which underwent a remarkable evolution during the epidemic period.
- Published
- 2012
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47. [Bacteriological profile of urinary tract infections in women in Aziza Othmana Hospital: 495 cases].
- Author
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Thabet L, Messadi AA, Meddeb B, Mbarek M, Turki A, and Ben Redjeb S
- Subjects
- Anti-Bacterial Agents therapeutic use, Drug Resistance, Multiple, Bacterial, Female, Humans, Tunisia, Urinary Tract Infections drug therapy, Urinary Tract Infections microbiology
- Abstract
Background: Urinary infection is a frequent pathology in the community as well as at the hospital., Aim: To analyze the profile of bacteria isolated from urinary tract infectious in women and their antimicrobial resistance., Methods: During two year period (1 January 2005 to 31 December 2006), 4536 urinary specimens were analyzed at the Laboratory of Aziza Othmana Hospital. All bacteria isolated from urinary tract infection (UTI) at women were retrospectively reviewed., Results: 495 cases of UTI were collected during this period. They were recovered from out patients (67%) or from hospitalized patients in Gynecology and obstetrics (23%). Enterobacteriacae were the most frequently identified strains (90.4%) including Escherichia coli (71%). The identified strains presented natural resistance and a high frequency of acquired resistance to betalactams(60.3% of E.coli, 72% of P.mirabilis were resistant to amoxicillin)and cotrimoxazole(30.4% of E.coli, 19,1 of K.pneumoniae, 21.4% of P.mirabilis). 5.7% of K.pneumoniae and 1.8% of E.coli were producing extended spectrum betalactamase(ESBL). Aminoglycosides remained active on enterobacteriacae(resistance to amikacin<14%,gentamicin<5%).Ofloxacin was highly active against enterobacteriacae (resistance<14%), Conclusion: Enterobacteriacae were the most frequent species in women urinary tract infection. Among these isolates, a high frequency of acquired resistance to betalactams and cotrimoxazole was shown. Aminoglysosides and fluoroquinolones remained the most active drugs. In every case antibiotherapy should have been prescribed after performing an antibiogram for each strain. These data were useful for the first line antibiotherapy, however the antimicrobial susceptibility testing is necessary for the rational use to limit the highly active drugs to multiresistant strains.
- Published
- 2010
48. The impact of fluoroquinolones use on antibiotic resistance in an intensive care burn department.
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Thabet L, Memmi M, Turki A, and Messadi AA
- Subjects
- Drug Utilization statistics & numerical data, Humans, Intensive Care Units, Burns complications, Drug Resistance, Multiple, Bacterial, Fluoroquinolones therapeutic use, Sepsis drug therapy
- Abstract
Background: Fluoroquinolones (FQ) use has been identified as a risk factor for colonization and infection to methicillin resistant Staphylococcus aureus(MRSA), Pseudomonas aeruginosae multiresistant(PMR), Acinetobacter multiresistant (AMR) and multidrug resistant bacteria(MDRB)., Aim: Our study proposes to measure the annual antibiotic use of FQ and antimicrobial resistance in P. aeruginosa, S. aureus, Klebsiella pneumoniae and A. baumannii in an intensive care burn unit., Methods: The study was conducted during a 4 year period (1 January 2000 to 31 December 2003). Antimicrobial susceptibility testing was performed using the disk diffusion method as recommended by the French Society of Microbiology. The consumption of the following antibiotics: ofloxacin, ciprofloxacin was expressed as the antimicrobial use density (AD) taking into account the quantity of antibiotics in Grams converted to defined daily doses (DDD) and the number of day hospitalization. Statistical significance was defined as p value < 0. 0 5 for the corresponding correlation coefficient., Results: There were statistically significant relationship between use of ciprofloxacin and resistance in P. aeruginosa to this drug (rs=0. 95, p<0. 05). Moreover, the ciprofloxacin consumption was correlated with resistance to imipenem (rs=0. 95, p<0. 05) and ceftazidime (rs=0. 95, p<0. 05) in P. aeruginosa . A restriction use of ciprofloxacin has been taken during 2003, it is followed by a significant decrease of resistance to imipenem, ceftazidime and ciprofloxacin in P. aeruginosa (p<0, 05 ). The use of fluoroquinolones was correlated significantly with MRSA (rs=0. 96, P<0. 05) . The restriction use of FQ was significantly associated with a decrease of MRSA. The consumption of ciprofloxacin was also correlated (P<0. 05) with resistance of ceftazidime in K. pneumoniae. However, there is not a correlation (P> 0. 05) between fluoroquinolones use and resistance in A. baumannii as well in ciprofloxacin, imipenem and ceftazidime., Conclusion: Our study illustrates the pressure of selection of fluoroquinolones use in the development of MDRB. The use and or the duration of treatment with theses antibiotics should be rationalised as part of efforts to control the emergence of multidrug resistant bacteria.
- Published
- 2010
49. [Bacteriological profile and antibiotic resistance of bacteria isolates in a burn department].
- Author
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Thabet L, Turki A, Ben Redjeb S, and Messadi Aa
- Subjects
- Humans, Retrospective Studies, Tunisia, Bacteria isolation & purification, Burn Units, Drug Resistance, Bacterial
- Abstract
Background: Nosocomial infections remain the main cause of morbidity and mortality in burn patients. Ongoing surveillance of infections in burned patients is essential to detect changes in epidemiology and to guide better empirical antibiotherapy and infection control policies. The aim of this study is to analyze the bacterial flora and the antibiotic resistance of isolates in a burn department during a two year period, Methods: From 1 January 2005 to 31 December 2006, 1268 strains were isolated from different specimens. Antimicrobial susceptibility testing has been carried out by disk diffusion method as referred to the French Society of Microbiology. All data were stored in a laboratory data base using whonet 5.3 software. Duplicate isolates defined as the same bacterial species for the same patient with the same antimicrobial susceptibility profile were excluded., Results: The most frequently identified species were Staphylococcus aureus (19.8%), Pseudomonas aeruginosa (15.8%), Acinetobacter baumannii (11.8%), Providencia stuarttii. The rate of meticillin resistant S. aureus was 68.1%, all isolates were fully susceptibles to glycopeptide. P. aeruginosa resistance was 35.6% and 35.4% respectively for ceftazidime and imipenem. Concerning A. baumannii, 98.7% of strains were resistant to ceftazidime, 59.5% to imipenem and 87.5% to ciprofloxacin. 77.3% of P. stuarttii isolates were resistant to ceftazidime and were producing extended spectrum, lactamase (ESBL). The frequencies of resistance to ceftazidime, of loxacin and amikacin of K. pneumoniae were respectively 60.9%, 25.4% and 47.1%., Conclusion: Comparatively to the previous years, S. aureus still be the commonest pathogen in the burn department. The incidence of antimicrobial resistance has decreased during 2006 after a peak of multiresistance during 2005. Our results should be helpful in providing useful information regarding antimicrobial resistance among the burn isolates and this will help in formulation of effective guideline for therapy.
- Published
- 2008
50. [Surveillance of multidrug resistant bacteria in a Tunisian hospital].
- Author
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Thabet L, Messadi Aa, Mbarek M, Turki A, Meddeb B, and Ben Redjeb S
- Subjects
- Acinetobacter baumannii drug effects, Anti-Bacterial Agents pharmacology, Ceftazidime pharmacology, Cephalosporins pharmacology, Cross Infection microbiology, Cross Infection prevention & control, Drug Therapy, Combination, Enterobacteriaceae drug effects, Humans, Imipenem pharmacology, Microbial Sensitivity Tests, Practice Guidelines as Topic, Pseudomonas aeruginosa drug effects, Retrospective Studies, Staphylococcus aureus drug effects, Tunisia epidemiology, Bacterial Infections drug therapy, Bacterial Infections epidemiology, Bacterial Infections prevention & control, Burns microbiology, Drug Resistance, Multiple, Bacterial, Hospitals, Urban, Sentinel Surveillance
- Abstract
Background: Controlling antibiotic resistance of bacteria is a priority for public healthcare., Aim: This study concerned the frequency of multidrug resistant bacteria (MDRB) in a Tunisian Hospital with the aim of establishing guidelines for MDRB prevention., Methods: The study was conducted during two years (1 January 2005-31 December 2006). Samples collected for the clinical diagnostic were included. The MDRB concerned were: methicillin resistant Staphylococcus aureus(MRSA), Enterobacteriacae resistant to of third generation cephalosporin (ER3GC), Acinetobacter baumannii resistant to both imipenem and ceftazidime, Pseudomonas aeruginosa resistant to both imipenem and ceftazidime., Results: During the study period, 2475 bacteria were tested by disk diffusion. 597 MDRB were collected, the rate of MBR was 24.1%. These MDRB were mainly recovered in burn unit (82.6%). ER3GC (47%) and MRSA (29,2%) were the most frequent MDRB. A. baumannii and P. aeruginosa multiresistant concerned 14,8% and 9% of MDRB. MDRB were isolated mainly from blood cultures (45%). The rate of MRSA was 46.4% among 375 strains of S. aureus. ER3GC represented 25,6% among 1096 isolates. Concerning A. baumannii and P. aeruginosa, 51.7% and 20.5% were resistant to both imipenem and ceftazidime among 170 and 264 isolates. Antibiotic resistance evolution showed a decrease of resistance in 2006 versus 2005. This decrease should be explained by the improvement of hygiene measure especially hand washing with the introduction of hydro- alcoholic solutions, a better targeted antibiotherapy promoted by a close cooperation between microbiologists and clinicians., Conclusion: The MDRB were frequent in our hospital. They were mainly isolated from the burn department. The measures of prevention already implemented are effective and must be strengthened with the continuous surveillance of MDRB.
- Published
- 2008
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